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Mangera A.,University of Sheffield | Bullock A.J.,University of Sheffield | Chapple C.R.,Sheffield Teaching Hospitals NHS Trust | MacNeil S.,University of Sheffield
Neurourology and Urodynamics | Year: 2012

Aims Progressive weakness in pelvic floor tissues is extremely common and leads to the distressing problems of stress urinary incontinence (SUI) and pelvic organ prolapse (POP). There has been extensive work on a vast array of materials spanning synthetics, autografts, allografts, and xenografts. Uniaxial testing of materials has been used to predict their success and rates of erosion. We aimed to compare the uniaxial properties of prostheses to native paravaginal tissue and correlate these to their success and erosion rates. Methods We performed a systematic review of the literature to identify the biomechanical properties of paravaginal tissue and of prostheses used in the treatment of SUI and POP. We examined to what extent these findings correlated to their reported success and erosion rates. Results Biomechanical properties have been determined for prostheses used in the treatment of POP and SUI both pre- and post-implantation in animal models. Implantation generally led to a decrease in ultimate tensile strength and Young's modulus. We were unable to find any simple correlation between the uniaxial mechanical properties of materials and their success or erosion rates. Conclusions Mechanical properties of prostheses, as measured by uniaxial testing, only appears to form part of the picture. We suggest implant integration and host responses to materials, as well as the biomechanical properties of the materials need to be considered to design materials to achieve lasting clinical benefit. © 2011 Wiley Periodicals, Inc. Source


Mills S.,University of Sheffield | Bryden D.C.,Sheffield Teaching Hospitals NHS Trust
Journal of Medical Ethics | Year: 2010

Teaching medical ethics and law has become much more prominent in medical student education, largely as a result of a 1998 consensus statement on such teaching. Ethics is commonly taught at undergraduate level using lectures and small group tutorials, but there is no recognised method for transferring this theoretical knowledge into practice and ward-based learning. This reflective article by a Sheffield university undergraduate medical student describes the value of using a studentselected component to study practical clinical ethics and the use of a clinical ethics checklist. The ethical checklist was proposed by Sokol as a tool for use by medical staff during the ward round to prompt the consideration of important ethical principles in relation to care. This paper describes additional uses for the checklist as a tool for teaching and learning about the practical application of ethical principles and for observing professional behaviours within a critical care and acute care environment. Evidence suggests that putting ethical behaviour into practice offers a far greater challenge to a newly qualified doctor than has been appreciated, and that more needs to be done at an undergraduate level to help combat this. This paper argues from a personal standpoint of an individual student experience that this can best be done in a clinical medical setting. Source


Williams D.P.,University of Oxford | Blakey C.M.,Sheffield Teaching Hospitals NHS Trust | Hadfield S.G.,South West London Elective Orthopaedic Center | Murray D.W.,University of Oxford | And 2 more authors.
Journal of Bone and Joint Surgery - Series B | Year: 2013

The Oxford knee score (OKS) is a validated and widely accepted disease-specific patient-reported outcome measure, but there is limited evidence regarding any long-term trends in the score. We reviewed 5600 individual OKS questionnaires (1547 patients) from a prospectively-collected knee replacement database, to determine the trends in OKS over a ten-year period following total knee replacement. The mean OKS pre-operatively was 19.5 (95% confidence interval (CI) 18.8 to 20.2). The maximum post-operative OKS was observed at two years (mean score 34.4 (95% CI 33.7 to 35.2)), following which a gradual but significant decline was observed through to the ten-year assessment (mean score 30.1 (95% CI 29.1 to 31.1)) (p < 0.001). A similar trend was observed for most of the individual OKS components (p < 0.001). Kneeling ability initially improved in the first year but was then followed by rapid deterioration (p < 0.001). Pain severity exhibited the greatest improvement, although residual pain was reported in over two-thirds of patients post-operatively, and peak improvement in the night pain component did not occur until year four. Post-operative OKS was lower for women (p < 0.001), those aged < 60 years (p < 0.003) and those with a body mass index > 35 kg/m2 (p < 0.014), although similar changes in scores were observed. This information may assist surgeons in advising patients of their expected outcomes, as well as providing a comparative benchmark for evaluating longer-term outcomes following knee replacement. © 2013 British Editorial Society of Bone & Joint Surgery. Source


Mangera A.,Sheffield Teaching Hospitals NHS Trust | Andersson K.-E.,Wake forest University | Apostolidis A.,Aristotle University of Thessaloniki | Chapple C.,Sheffield Teaching Hospitals NHS Trust | And 4 more authors.
European Urology | Year: 2011

Context: The use of botulinum toxin A (BoNTA) in the treatment of lower urinary tract dysfunction has expanded in recent years and the off-licence usage list includes neurogenic detrusor overactivity (NDO), idiopathic detrusor overactivity (IDO), painful bladder syndrome (PBS), and lower urinary tract symptoms resulting from bladder outflow obstruction (BOO) or detrusor sphincter dyssynergia (DSD). There are two commonly used preparations of BoNTA: Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA). Objective: To compare the reported outcomes of onabotulinumtoxinA and abobotulinumtoxinA in the treatment of NDO, IDO, PBS, DSD, and BOO for adults and children. Evidence acquisition: We performed a systematic review of the published literature on PubMed, Scopus, and Embase in the English language reporting on outcomes of both BoNTA preparations. Review articles and series with <10 cases were excluded. The articles were graded for level of evidence and conclusions drawn separately for data with higher-level evidence. Evidence synthesis: There is high-level evidence for the use of onabotulinumtoxinA and abobotulinumtoxinA in adults with NDO but only for abobotulinumtoxinA in children with NDO. Only onabotulinumtoxinA has level 1 evidence supporting its use in IDO, BOO, DSD, and PBS/interstitial cystitis. Conclusions: We identified good-quality studies that evaluated onabotulinumtoxinA for all the indications described above in adults; such was not the case with abobotulinumtoxinA. Although this does not imply that onabotulinumtoxinA is more effective than abobotulinumtoxinA, it should be a consideration when counselling patients on the use of botulinum toxin in urologic applications. The two preparations should not be used interchangeably, either in terms of predicting outcome or in determining doses to be used. © 2011 European Association of Urology. Source


Quinn T.,Sheffield Teaching Hospitals NHS Trust | Verma P.K.,Sheffield Teaching Hospitals NHS Trust
Ultrasound | Year: 2014

National guidelines for routine ultrasound quality assurance include the measurement of transducer sensitivity using the in-air reverberation pattern generated from a transducer operating in air. The in-air reverberation method has been compared with other well-known measures of transducer sensitivity, such as the Sonora FirstCall probe tester (Sonora Medical Systems Inc, Longmont, CO, USA) and phantom-based images. There is good agreement between the in-air reverberation images and the Sonora FirstCall probe data for individual crystal sensitivity. However, the in-air reverberation approach is cheaper and easier to implement for linear and curvilinear transducers. The methods used for measuring the in-air reverberation pattern and the influence of scanner parameters such as gain and output power have been investigated. In general, reliance on a visual assessment of reverberation depth can lead to inconsistencies in the measurement of reverberation depth, when taken over a period of several months. The value of scanner parameters, in particular scanner gain, is also important when trying to measure changes in reverberation depth due to changes in transducer performance. A more accurate assessment of changes in transducer sensitivity, using the in-air reverberation method, is found by measuring the peak pixel grey scale values within a chosen reverberation band in the image. This quantitative approach can be taken a step further by assessing changes within the whole in-air reverberation pattern, by applying a two-dimensional cross correlation between two reverberation images to assess changes in transducer performance. Source

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